| NPI | 1982715264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 239041) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC APN2484) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-07-15 |